Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is bladder cancer?

Bladder cancer is an uncontrolled abnormal growth and multiplication of cells in the urinary bladder, which have broken free from the normal mechanisms that keep uncontrolled cell growth in check. Bladder cancer (like cancers of other organs) has the ability to spread (metastasize) to other body parts, including the lungs, bones, and liver.

Bladder cancer invariably starts from the innermost layer of the bladder (for example, the mucosa) and may invade into the deeper layers as it grows. Alternately, it may remain confined to the mucosa for a prolonged period of time. Visually, it may appear in various forms. Most common is a shrub-like appearance (papillary), but it may also appear as a nodule, an irregular solid growth or a flat, barely perceptible thickening of the inner bladder wall (see details in subsequent sections).

What is the burden of bladder cancer in the U.S.?

Bladder cancer has the dubious distinction of inclusion on the top 10 list of cancers, with an estimated 74,690 new cases occurring in 2013-2014 within the U.S. Bladder cancer is three to four times more likely to be diagnosed in men than in women and about two times higher in white men than in African-American men. Bladder cancer killed an estimated 15,210 people in 2013. In the U.S., the lifetime bladder cancer risk for men is about one in 26 and for women about one in 90.

What are the types of bladder cancer?

Bladder cancer is classified on the basis of the appearance of its cells under the microscope (histological type). The type of bladder cancer has implications in selecting the appropriate treatment for the disease. For example, certain types may not respond to radiation and chemotherapy as well as others. The extent of surgery required for maximizing the chances of cure may also be impacted by the histological type of the cancer. In addition, bladder cancers are often described based on their position in the wall of the bladder. Noninvasive bladder cancers are located in the inner layer of cells (transitional cell epithelium) but have not penetrated into deeper layers. Invasive cancers penetrate into the deeper layers such as the muscle layer. Invasive cancers are more difficult to treat.

The more common types of bladder cancer and their relative incidence are given below:

Urothelial carcinoma (previously known as "transitional cell carcinoma") is the most common type and comprises 90%-95% of all bladder cancers. This type of cancer has two subtypes, papillary carcinoma (growing finger-like projections into the bladder lumen) and flat carcinomas that do not produce fingerlike projections. Urothelial carcinoma (transitional cell carcinoma) is strongly associated with cigarette smoking.

Adenocarcinoma of the bladder comprises about 1%-2% of all bladder cancers and is associated with prolonged inflammation and irritation. Most adenocarcinomas of the bladder are invasive.

Squamous cell carcinoma comprises 1%-2% of bladder cancers and is also associated with prolonged infection, inflammation, and irritation such as that associated with longstanding stones in the bladder. In certain parts of the Middle East and Africa (for example, Egypt), this is the predominant form of bladder cancer and is associated with chronic infection caused by Schistosoma worm (a blood fluke, that causes schistosomiasis, also termed bilharzia or snail fever).